Ch. 6 Ct Exam And Anatomy Part. 1 Flashcards
Indications Ct exam of the head p 7
Trauma, stroke, headache, tumors, endocrine disease, inflammatory disease, and congenital problems
Ct exam head _____ slices always required p 7
Transverse
Ct exam of head requires coronal and sagital slices for p 7
Internal auditory canals, temporal bones , pituitary, orbits, sinuses and facial bones
Ct of head patient enter gantry p 7
Head first supine
Two ways obtaining coronal images of head p 7
Patient supine and head first Hyperextended patien head and top gantry tilted 20 degrees
Patient prone and head first resting on chin and gantry tilted back 20 degrees
Localizer of head ct is what image? P 7
Lateral
Iv contrast for head ct administered ? P 8
Highlight vascular structures of the brain to indicate a disruption of the blood brain barrier
Ct exam of brain patient entered gantry p 9
Head first and supine
Contrast media not admixtures for exam of brain p9
Cerebral trauma
Suspected atrophy
Hydrocephalus
Dementia
Contrast administered for ct of brain p 9
Tumors Abscesses Edema Aneurysm Headaches and seizures
Axial slices of brain acquired from the ______ to _____. P 9
Skull base
Vertex
Typical brain slice thickness reconstruction p 9
5mm slices
Why thinner slices on ct of brain? P 9
Reduce streaks scanning through posterior fossa and pretrous ridges
Routine brain scan technique p 10
300 ma kvp 120
Bone window level of head p 11
Width: 2500
Level - 350
Posterior fossa window width and level p 11
Width: 200
Level: 40
Soft tissue of head window width and level p 11
Width: 100
Level: 30
Ct posterior fossa scan ( skull base) p 16
Head first supine scan
Axial slices only
From foramen magnum through the tentorium
Posterior fossa scan no contrast medium p 16
Cerebral trauma
Suspected atrophy
Hydrocephalus
Dementia
Posterior fossa scan contrast administered p 16
Tumors Abscesses Edema Aneurysms Headaches Seizures
Posterior fossa scan slice thickness p 16
1.5-5mm
Mas for posterior fossa scan p17
300-400 mas
Posterior fossa bone detail ww/wl
2500 ww and 350 wl
Posterior fossa soft tissue window p 16
Ww 160 and wl 40
I nternal auditory canal / temporal bones contrast exam p 18
Hearing loss to,rule out acoustic neuroma and malignant Ottis externa
I nternal auditory canal / temporal bones without contrast p 18
Depict temporal bone , mastoiditis, and cholestatoma
Instructions for study of I nternal auditory canal / temporal bones p 18
No swallowing
Slices thickness of I nternal auditory canal / temporal bones
0.5-2mm
I nternal auditory canal / temporal bones exam covers from? P 18
1cm inferior external auditory canal and superiorly petrous bone
Mas used for I nternal auditory canal / temporal bones p 19
200-400 mas
I nternal auditory canal / temporal bones technique
200-400 mas
I nternal auditory canal / temporal bones standard filter vs sharp filter p 19
Standard - soft tissue
Sharp - High resolution
I nternal auditory canal / temporal bones soft tissue window p 20
Ww- 200, wl- 50
I nternal auditory canal / temporal bones sharp algorithmn p 20
Ww- 2500
wl-300
Pituitary exam p 22
Head first and supine
Both axial and coronal
Contrast always administered
Pituitary exam _____ provide more information because _____ exam causes streak artifacts from dense bone of sella turcica
Coronal
Axial
Pituitary slice thickness p 22
0.5-2mm
Pituitary axial slices show p 22
Roof of sphenoid sinus through dorsum sella
Pituitary Coronal slices show p 22
Anterior clinoid process to dorsum sella
Pituitary exam mas p 23
200-400 mas
Pituitary soft tissue ww/wl p22
Ww-200
Wl-50
Pituitary sharp algorithmn ww/wl p 23
Ww-2500
Wl- 300
Orbit exam p 24
Axial and coronal images acquired
Head first and supine
Patient instructed to focus eyes on one thing or close them
No contrast media orbit exam p 24
Trauma, foreign bodies, Graves’ disease
Contrast for orbit exam p 25
Suspected mass in or around eye , visual disturbances, evaluating infection
Orbit exam slice thickness p 24
2mm or less
Axial images of orbits from p 24
Top maxillary sinus to upper orbital rim
Coronal slices orbit exam p 24
Sphenoid sinus to anterior globe
_______ images of orbits best demonstrate the relationship between the lens and intraorbital optic nerve
Transverse
Orbit exam mas p 26
200
Orbit soft tissue ww/wl p 26
Ww-200
Wl- 50
Orbit sharp algorithmn p 26
Ww- 2500
Wl- 300
Sinuses exam p 29
Both axial and coronal slices
Head first and supine
Contrast for sinuses p 29
Suspected mass such as lymphoma or inverted papilloma
No contrast for sinus exam p 29
Sinusitis
Sinus exam slices p 29
3 mm or less
Sinus axial exam from p 29
Hard palate through superior aspect frontal sinus
Coronal slices for sinus exam p
Dorsum sella to anterior aspect of frontal sinuses
Sinus exam mas p 30
200 mas
Sinus soft tissue p 30
Ww- 250
Wl- 50
Sharp algorithmn sinus p 31
Ww- 2000
Wl- 300
Facial bone exam p 34
Axial or coronal slices
Supine and head first
Why no contrast facial bone exam ? P 34
Head trauma
Facial bone slice thickness
0.5-3. Mm
Facial bone scan coverage ? P 34
Hard palate through superior aspects of cranium
Facial bone mas p 34
250
Facial bone soft tissue ww/wl p 34
Ww- 300
Wl- 50
Facial bone sharp algorithmn ww/wl p 34
Ww- 2500
Wl- 300
Tmj scan p 38
Supine head first
Always oblique sagittal scan -
Tmj scan done for
Fracture or bony erosion
Tmj slice thickness p 38
2mm
Tmj mas
250 mas
Tmj bone ww/wl
Ww- 2500
Wl- 350
Tmj soft tissue window
Ww- 180
Wl- 40
Cta is commonly used to evaluate
Intercranial aneurysms and vascular occlusion
Cta of brain p 42
Head first and supine
100 ml contrast at rate 4-4.5 ml/sec
Scan 24 secs after start of injection
Cta of brain scan from
C2- three quarters of brain
Cta brain technique
120 kvp at 250 mas
Ct brain perfusion done for ?p 44
Assessment of tissue viability and function after stroke
Size gauge needle used for ct brain percussion
Large 16 or 18
Ct perfusion contrast flow rate ? P 46
5-8 ml/ sec
Ct brain perfusion slice thickness p 46
5mm
Ct neck used for p 48
Eval tumors, inflammation, or infection, developmental anaomolies
Why contrast in ct neck? P 48
Differentiate boodvessels and vascular tumors from lymph nodes
Ct exam neck p 49
Head first supine
Axial slices
Patient instructed stop breathing or refrain swallowing
Ct neck row rate
100 ml injected at rate of 3ml/sec with 35 sec delay
Ct neck slice thickness
2-5 mm
Ct neck technique
120kvp
120 mas
Ct larynx p 53
Head first and supine
Phonate “e” to evaluate vocal chord
Ct larynx flor rate
100 ml /s rate 3ml per sec with delay 35 sec
Ct larynx slice thickness
2mm
Ct larynx ww/wl
Ww-300
Wl- 40
Cta neck p 55
Head first and supine
Shoulders depressed
Cta neck injection p 55
100 ml at rate 4-4.5 ml/ sec with iv in arm opposite of suspected occlusion with 15 sec delay
Cta scan through p 55
From aortic arch through sella turcica
Cta exam technique p55
120 kvp at 200 mas
Cta neck best shows ? P 55
Carotid artery stenosis
Why ct of the spine ? P 57
Trauma Intraspinal tumors Disc herniation Spinal infection Spinal stenosis Metastic disease fractures
Lateral localizer images for spine allows p 58
Angle slices through each disc space
Ap localizer on the spine allows p 58
Guarantees patient spine is straight and allows us to count ribs to locate thoracic spine
Why iv contrast of spine ? P 58
Mass is suspected or for evaluation of post surgical spine
Ct cervical spine p 59
Head first and supine
Patient refrain from swallowing due to motion
Depress patient shoulders avoid beam hardening artifact
Ct cervical contrast used? P 59
Suspected mass
Ct cervical slice thickness p 59
2mm overlapping slices
Standard ct cervical ww/wl p 59
Ww- 300
Wl- 40
Ct cervical sharp ww/wl p 62
Ww- 2000
Wl- 300
Ct of T spine p 63
Supine head first
Ct of t spine when use contrast? P 63
Suspected mass
Ct of t spine slice thickness p 63
2-3 mm
T spine standard ww/wl p 64
Ww- 300
Wl- 40
T spine sharp ww/wl p 64
Ww- 2000
Wl- 300
Ct of L spine p 68
Head first and supine
Wedge under patient legs reduce lordatic curve
Ct of L spine contrast when? P 68
Suspected mass
Differentiate scar tissue from recurrent disc disease in post surgical spine
Ct of L spine slice thickness p 68
2-3 mm slices
Ct L spine standard ww/wl p 70
Ww- 300
Wl- 40
Ct of L spine sharp ww/wl p 70
Ww- 2000
Wl - 300
Ct myelogram p 73
Contrast introduced into fluid space around spinal chord( subarchnoid space) under Fluor
Why ct myelogram p 73
Spinal Chord
Nerve roots
Meninges
Assist pre op planning
Ct discogram p 73
Contrast agent directly into suspect pain generating dicsc under Fluro
Why discogram p 73
Planning for surgery whether do discectomy or fusion
Ct myelogram/ discogram positioning p 73
Supine head first
Head slightly elevated to reduce headache or seizure from contrast
Ct myelogram/ discogram slice thickness p 74
2-3 mm slices
Ct myelogram/ discogram standard ww/wl p 75
Ww- 300
Wl- 40
Ct myelogram/ discogram sharp algorithmn p 75
Ww- 2000
Wl- 300
Musculoskeletal ct indications p 76
Lesions
Trauma
Joint spaces
Musculoskeletal contrast evals for? P 76
Vascularity of tumors
Demonstrate major arteries or veins
Shoulder ct p 78
Head first supine
External or internal rotation
Opposite arm raised
Ct shoulder area of interest p 78
Clavicle through humeral head
Shoulder ct slice thickness p 78
1.5-5mm
Ct shoulder technique p 78
300 mas
Ct shoulder when contrast is used ? P 78
Post arthrogram
Elbow ct p 81
Patient supine arm raised palm up
Ct elbow slice thickness p 81
0.5-3mm slices
Ct elbow soft tissue setting p 83
Ww- 400
Wl- 20
Ct elbow bone setting p 83
Ww- 2000
Wl- 350
Ct wrist p 84
Head first or supine arm out above head
Ct wrist slice thickness p 84
0.5-3mm
Ct wrist soft tissue setting p 85
Ww- 400
Wl- 20
Ct wrist bone setting p 85
Ww- 2000
Wl- 350
Ct hips p 86
Head first or feet first
Toes 15 degree inward
Ct hip slice thickness p 86
1.5-5mm
Ct hip mas p 86
200-300 mas
Ct hip soft tissue p 87
Ww- 400
Wl- 20
Ct hip bone setting p 88
Ww- 2000
Wl- 350
Ct knee p 88
Feet first or supine with both knees symmetrical to long axis of patient table
If one knee only , center it on table
Ct knee slice thickness p 88
0.5-3 mm
Ct knee mas p 88
100-200
Ct knee soft tissue setting p 89
Ww- 400
Wl- 20
Ct knee bone setting p 89
Ww- 2000
Wl- 350
Ct ankle/ foot p 90
Feet first and supine
Foot- flat on table
Ankle - legs straight and flexed naturally
Ct ankle/ foot slice thickness p 90
0.5-2mm
Ct ankle / foot mas p 90
75-200 mas
Ct ankle / foot soft tissue setting p 91
Ww- 400
Wl- 20
Ct ankle / foot bone setting p 91
Ww- 2000
Wl- 350
Ct runoff area of interest p 94
Upper abdomen to below ankles
Ct runoff p 96
Feet first and supine
Ct runoff contrast p 96
125 ml injected 4 ml/sec with delay 3 mins post injection
Ct runoff technique p 96
120 kvp 200 mas